Journal Reviews

Rogers FB, Rozycki GS, Osler TM, et al. A multi-institutional study of factors associated with fetal death in injured pregnant patients. Arch Surg 1999; 134:1,274-1,277.

Fetal deaths in injured pregnant patients are linked with increased injury severity and abnormal maternal physiologic profile and could potentially be prevented with the routine use of cardiotrophic monitoring (CTM), according to this five-year retrospective review of pregnant trauma admissions at 13 Level I and Level II trauma centers. CTM is used to detect potentially threatening fetal heart rates.

Here are key findings:

1. Injured pregnant patients comprised 1.3% of female admissions, and of those, 84% had blunt injuries and 16% had penetrating injuries.

2. There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%).

3. The population suffering fetal death had higher injury severity scores, lower Glasgow Coma Scale scores, and lower admitting maternal pH.

4. An injury score over 25 was associated with a 50% fetal mortality rate.

5. Most women who lost their fetus arrived in shock or had a fetal heart rate of less than 110 beats/min at some time during their hospitalization.

6. CTM was performed on only 61% of pregnant women in their third trimester.

7. Factors linked with increased fetal mortality were increasing injury score, decreasing Glasgow Coma Score, maternal shock, acidosis (an abnormal increase in hydrogen in the body, such as rental tubular acidosis), and a decrease in fetal heart rate.

CTM may decrease mortality

CTM is underused in injured pregnant patients in their third trimester, even after admission to major trauma centers, say the researchers.

"Increased use of cardiotrophic monitoring may decrease the mortality caused by placental abruption," they suggest.

"Increased awareness of the importance of routine CTM in the pregnant trauma patient may help decrease the incidence of fetal mortality associated with abruption in this population."